Racial and socioeconomic disparities in surgical care for post‐prostate cancer treatment complications: A nationwide Medicare‐based analysis

Abstract

AbstractObjectivesTo investigate the racial and socioeconomic (income) differences in receipt of and time to surgical care for urinary incontinence (UI) and erectile dysfunction (ED) occurring post‐radical prostatectomy (RP) and/or radiation therapy (RT).Materials and MethodsUtilizing the Medicare Standard Analytical Files (SAF), a retrospective cohort study was performed on data of patients diagnosed with prostate cancer (PCa) from 2015 to 2021. Patients who underwent RP and/or RT and who subsequently developed UI and/or ED were grouped into four cohorts: RP‐ED, RP‐UI, RT‐ED and RT‐UI. County‐level median household income was cross‐referenced with SAF county codes, classified into income quartiles, and used as a proxy for patient income status. The rate of surgical care was compared between groups using two‐sample t‐test and log‐rank test. Cox proportional hazards modelling was used to determine covariate‐adjusted impact of race on time to surgical care.ResultsThe rate of surgical care was 6.8, 3.61 3.07, and 1.54 per 100 person‐years for the RP‐UI, RT‐UI, RP‐ED, and RT‐ED cohorts, respectively. Cox proportional ‘time‐to‐surgical care’ regression analysis revealed that Black men were statistically more likely to receive ED surgical care (RP‐ED AHR:1.79, 95% CI:1.49–2.17; RT‐ED AHR:1.50, 95% CI:1.11–2.01), but less likely to receive UI surgical care (RP‐UI AHR:0.80, 95% CI:0.67–0.96) than White men, in all cohorts except RT‐UI. Surgical care was highest among Q1 (lowest income quartile) patients in all cohorts except RT‐UI.ConclusionsSurgical care for post‐PCa treatment complications is low, and significantly impacted by racial and socioeconomic (income) differences. Prospective studies investigating the basis of these results would be insightful.